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A Newsletter for Parents

6-10 Year Check UpWell Child Appointments can be made online at AustinRegionalClinic.com.

NUTRITIONElementary school years continue to be important in shaping your child’s lifelong health habits.

If you are concerned that your child might need to make some changes to be healthier, always discuss them as choices the whole family will be making. Children this age detect and point out differences in what a parent is asking the child to do and what the parent or other siblings are doing. Parents need to set boundaries for healthy eating and activity, but should ask for input from their children.

Healthy eating habits begin with your grocery choices. Choose lots of fruits and vegetables, and encourage your children when they try new ones. Buy only small quantities of snack foods and treats, if any, and save yourself money by not buying sweetened drinks. Water and low-fat (1%) or nonfat (skim) milk are the best drinks for your child to drink.

Family meals (everyone sitting together at the table) are important and have been shown to contribute to increased communication between children and their parents, decreased high-risk behaviors like smoking and using drugs and alcohol during adolescence, and better grades.

Parents should serve meals restaurant style (portioning out food onto plates) instead of family style (everyone helping themselves from the food on the table).

Utilize the MyPlate visual guide to create well-balanced meals and snacks for your family.

School Lunches Once your child is attending school, you might have the option to get school breakfast and lunch. There are often healthy food choices on the menu, but make sure to review this menu with your child if you feel some are healthier than others. There might be a choice to add on snacks to your child’s lunch choices. These are often not healthy. Ask if you can block that choice on your child’s account.

If you feel the school cafeteria does not offer many healthy choices, parents can pack a healthy lunch each day.

▪ Make sure your child’s lunch includes fruits and vegetables.

▪ Skip the chips and treats. Consider adding boiled eggs, nuts, cheese, or low sugar yogurt instead.

▪ Pack a small water bottle, or encourage the child to buy low-fat milk in the cafeteria.

▪ Avoid pastrami, salami, and other high-fat lunch meats. (Use low-fat lunch meat with less than 3 grams of fat per ounce).

▪ Parents may also need to pack a healthy snack for after-school care or activities if one is not offered. If you have a long commute home with your child, consider having fruit or veggies ready for the drive home.

▪ Many children eat breakfast at school, so parents may want to check what that menu has to offer as well. Help your child choose cereals with lower sugar (less than 9g per serving) and at least 2 grams of fiber. You may want to pack some low-sugar cereal and fruit as an alternative to any unhealthy choices on the menu.

Healthy Habits TipsRemember the message “7-5-2-1-0” for what healthy habits are important for your child.

7: Eat breakfast 7 days a week. Eating breakfast jump-starts the metabolism, improves school performance, and prevents children from getting too hungry and overeating later in the day — habits that lead to excess weight.

5: Eat at least 5 servings of fruits and vegetables per day. By making ½ their

plate fruits and vegetables at meals and including fruits and vegetables for snack, your child will get the needed amount of fruits and vegetables.

2: Do not let your child spend more than 2 hours on total screen time per day (TV, video games, recreational computer time, tablets or phones).

1: Have your child participate in at least 1 hour of physical activity per day. This should be the activity of choice that your child prefers and often means just playing outside.

0: Encourage your child to drink almost no sugar sweetened beverages. Soda, sports drinks, fruit drinks, flavored (chocolate) milks, and even 100% fruit juice (collectively called sugar-sweetened beverages) all contain a large amount of sugar.

EXAMPLES OF HEALTHY SNACKS

• Fruit• Low-fat/frozen yogurt• Celery stalks, cucumber slices• Frozen banana slices• Bran muffins• Sugar-free cereals• Low-fat cheeses• Crackers or unsalted pretzels

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Is My Child Overweight/Obese?Body Mass Index (BMI) is widely used to help define overweight and obese children. BMI compares height and weight and varies by age and sex. A healthy BMI is less than 85th percentile. BMI and BMI percentile will be shared at your child’s visit. Do not hesitate to ask your child’s doctor about any concerns you have about their weight or eating habits.

FiberFiber comes from plants such as fruits, vegetables, and grains. Whole wheat and multigrain products have more fiber. Fiber is important in lowering blood cholesterol, reducing heart disease, and even preventing some cancers. A good rule for fiber intake is “Age Plus Five.” Your child’s age plus five equals the number of grams of dietary fiber they should eat daily. For example, a 7-year-old would need 12 grams of dietary fiber a day.

SCREEN TIME GUIDANCE Playing on phones and tablets has opened up many new opportunities to create and connect. However, this also brings along new perils, especially with prolonged screen time. Children experience cognitive delays and social/emotional delays with prolonged screen time. Executive planning (the ability to control impulses, regulate one’s own behavior and the ability to switch between things they are doing) is also affected. Parents should seek out high-quality educational products (for example, PBS Kids) or use resources that rate available app and movie choices (for example, Common Sense Media).

To promote responsible screen use, try these strategies to avoid common pitfalls:

▪ Make sure that other priorities come first. Exercise, family time, reading time, and a

regular bedtime should be part of your child’s daily routine. Prevent screen time from replacing or delaying any of those.

▪ No screens during meals (even background television viewing is problematic) and no screen use within one hour of bedtime.

▪ Avoid using the phone or tablet to calm your child. This rewards their whining or crying.

▪ Remove all screens out of the bedroom where your child sleeps starting the hour before bedtime. Set up a charging station in another area of the house.

Goals for media use at this age should include:

▪ Share the apps and shows your child is watching; this gives caregivers the ability to teach, to demonstrate limit-setting and to promote social interaction.

▪ Monitor all your children’s media. Test-drive applications before allowing your child to use them. Look for ones that show behaviors you would like to see in your child. Later, ask your child what they think of what they saw.

▪ Create “unplugged” spaces in the home. This might be your place where you eat meals or the place where you read together.

▪ Think about media limits for every family member. Your own screen use is a strong predictor of how frequently your children use screens. More parental use of screens leads to less interaction with children, less active play with children, and more parent-child conflict. The American Academy of Pediatrics has released a Media Use Toolkit, which can help parents set goals for your individual family. More information is available at: www.healthychildren.org/MediaUsePlan.

SLEEPAverage sleep for the early school age child ranges from 10 to 11 hours per night. Sometimes activities delay bedtime, but having a regular sleep routine is very

important. Not getting enough sleep leads to poor performance at school, trouble making healthy food choices — not to mention grumpy moods. Establish healthy sleep routines for your children, including set bedtimes and wake up times, even in the summer.

DEVELOPMENT Your six- to ten-year-old is in a period of great social and intellectual growth. They will begin to try new skills in the outside world that they have learned at home. Your child will become more independent while developing relationships with friends and continuing to be an important member of your family. The habits and behavior patterns that your child develops now will influence their health, well-being and success in school, work and close relationships for the rest of their life.

▪ You are your child’s most important role model. Whether you are responding to people less fortunate than yourself or choosing food, your child will be watching and imitating. Live the values you want your child to have.

▪ Communicate with your child. Find opportunities to listen to their thoughts and fears. The better you know your child, the better you’ll be able to meet challenges and help solve problems as they arise. Respect and even admire your child’s unique character and personal skills.

▪ Support your child in their ideas and be an advocate for them. Involve yourself in their activities, guiding and encouraging them.

Physical DevelopmentYour child will be growing steadily in these years. Most children this age grow about two inches a year. They may appear slim and their legs long in proportion to their bodies. Don’t worry if people tell you that your child is too skinny unless your doctor is concerned.

Online Access: Day or Night ▪ View your child’s medical records

▪ Print your child’s shot records any time

▪ Book your child’s next appointment

▪ Review your child’s After Visit Summary

— Enroll Today —Visit MyChartARC.com

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Language/SpeechDuring these years speech becomes very adult-like. By age 6 all vowel and most consonant sounds should be pronounced well: f, l, sh, th, v are often just becoming clear. By age 7 all consonants and all vowels should be pronounced well: ch, soft g as in George, r, s, wh, and z are often the final sounds to become clear. If pronunciation problems persist your child should be evaluated by a speech therapist.

Continue to read at least 30 minutes a day to your 6, 7, and 8 year old. By 9 or 10 your child may prefer to read their own books. Make sure there is quiet time to read.

School Make the effort to be involved in your child’s education by meeting with their teacher at the beginning of each school year. Find out the teacher’s expectations for your child’s work and classroom behaviors. Sometimes the easiest way to keep in touch with your child’s teacher is by sending a note or email whenever you have concerns, questions, or wish to set up a time to discuss their education.

If your child is having difficulties in school, you may consider the possibility of a learning disorder. Learning problems, especially if not evaluated and treated, may cause other emotional, behavioral and family problems. 10-20% of children may have a type of learning problem.

Examples of learning disorders are:

▪ Problems with academic skills such as reading, writing, math or spelling;

▪ Problems with language and speech;

▪ Problems with coordination, balance and writing.

All children have trouble focusing sometimes, but there are some children whose inability to focus affects their ability to learn or complete schoolwork that is typical for their grade.

Attention Deficit Hyperactivity Disorder is a developmental disorder that affects behavior, attention, and learning.

Children with ADHD may have increased distractibility, impulsiveness, problems concentrating, easy frustration and dramatic mood swings. If you think they may have ADHD, your child should have a complete check-up and consult with your child’s doctor. Your doctor may refer you to other professionals to help diagnose or rule out ADHD. If your child has ADHD, they may be eligible for support from their school.

Social Skills Children this age spend more time out of the house with peers and need to learn how to form friendships. Guiding children in finding good friends will help them thrive at school and beyond. Help your child identify good qualities in others: the ability to follow rules, the tendency to respect others, etc. Be a role model for your child by demonstrating relationship skills with your spouse and by nurturing friendships with others. Facilitate additional opportunities for your children to play with other children who may have a positive influence. Become your child’s confidant; good relationships with one’s parents have been shown to lead to more positive friendships with others. Lastly, share tips for how to handle bullies. Encourage your child to walk away from a bully and seek help from authority figures. Remind your child to continue to look for those relationships that help them feel happy and accepted.

Behavior and DisciplineAt this age, children are learning how to interact and behave in the world. They learn this by watching everyone around them, especially their parents. As a parent, you can model positive behavior in many ways. For example, you can point out positive behaviors such as sharing among adults, or model good ways to calm down. This could be:

“Daddy is sharing his drink with Mommy. Good job sharing, Daddy!”

“Mommy is really frustrated right now. Please help me calm down by taking 10 deep breaths with me.”

Additionally, where you direct your attention can play a big role in which behaviors children continue. Remember, Behavior + Attention = More Behavior! The best way to improve behavior is to give children lots of attention when they are doing something you like.

You can also think of this as “catching them being good.”

It is very important that clear expectations are set, so that children can understand the rules that apply to them. Make sure your expectations are realistic and age appropriate.

When the clear expectations that you set are broken, be sure to respond consistently each time, to follow through with discussed consequences, and to keep the consequence tied to the action. For example, if you set a family rule that all the family only rides a tricycle or bike with a helmet, and your child gets on without their helmet, then give them the consequence of no bike riding for a day.

Another effective discipline tool is calling a time-out. This works best by warning children they will get a time out if they do not stop, reminding them what they did wrong in a few words, and removing them from the situation for a pre-set length of time (1 minute per year of age is a good rule of thumb). You can also consider letting your child lead their own time out instead of setting a timer. You can say:

“Go to time out and come back when you feel ready and in control.”

This gives your child an opportunity to practice their emotional self-management skills.

Spanking, slapping, or aggressively yelling at or shaming a child are not effective at changing behaviors, and can also damage a child’s long-term physical and mental health. These are not recommended.

Body TalkTypically in the school age years, your child may begin to show an interest in how things work. They might have questions about their bodies. These are not adult sexual thoughts, but signs of normal curiosity. Know that these discussions will likely be ongoing over the course of their lives, rather than one time conversations. You will share more and more factual information as they get older. However, your child needs to learn what is all right to do and what is not. Setting limits to exploration is really a family matter. You may decide to teach your child the following:

▪ Interest in genital organs is healthy and natural.

▪ No other person, including even close friends and relatives, may touch “private parts.” The exceptions are 1) doctors and nurses during physical exams (but stress to your child that doctors and nurses need to have a parent in the room and ask permission from the child) and

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It is best to use smoke alarms that use long-life batteries, but if your do not, change the batteries once a year.

Gun Safety If you have children, it is best to not have a gun in your home. For those who keep a gun in the home, follow these safety rules:

▪ Always keep the gun unloaded and locked up.

▪ Lock and store the bullets in a separate place.

▪ Hide the keys to the locked boxes.

▪ Teach your child to leave a house or situation immediately if they see a gun, and ask the homes where your child visits if they have guns stored properly there.

2) their own parents when they are trying to find the cause of any pain in the genital area.

If you are uneasy talking about sex or answering certain questions, be honest about that too. Consider asking a relative, close family friend, or your doctor to help talk to your child.

Puberty Signs Toward the end of this time, puberty may begin. Girls may have breast bud development as early as 8 years old, but 10 years is the average. Boys may have enlargement of the testes and thinning of the scrotum at around age 11, but this may occur as early as 9 years. Soon after these early signs of puberty, pubic hair begins to appear. If your child is showing signs of puberty before these ages, please discuss this with your doctor.

DENTAL CAREThe following strategies can help prevent tooth problems:

▪ Brush your child’s teeth with a soft nylon toothbrush twice a day using a small amount (pea-sized) of a fluoride-containing toothpaste. Teach them to spit out the toothpaste after brushing.

▪ Make sure to brush right after eating sticky-sugary foods. These include raisins, sticky candies or gums, dried fruit, gummi “fruit snacks” or gummi vitamins.

▪ Drink fluoride-supplemented water.

▪ For patients insured by Medicaid, you can find a dental provider for your child at www.tmhp.com, or calling the THSteps Hotline at 877-847-8377.

SAFETY As your child becomes more indepen-dent, it is especially important to teach safety rules to your child.

Street Safety Make sure your child always wears a helmet while riding a bike, scooter or skateboard. Parents must wear helmets also. Wrist guards, knee pads, and elbow pads are a good idea for everyone; especially while on skateboards and skates.

Teach your child to ride on sidewalks. Children under 8 should not cross the street or ride on the street without adult supervision.

Be sure that your child’s bike is the right size. Your child must be able to place the balls of both feet on the ground when sitting on the

seat with hands on the handlebars.

We do not recommend hoverboards, 4-wheeler or all-terrain vehicles, or dirt bikes for children this age.

Car Safety Most children this age need to use a booster seat. Children who are less than 4’9” need to be in a belt-positioning booster seat. Always check that he or she is correctly restrained in the booster seat. Set a good example. Make sure that you and other adults buckle up. The safest place for children, even through school age, is in the backseat of a car. It is not recommended that they sit in the front seat of a car until they are 13 years of age.

Children can move out of the booster seat when the lap belt can be worn low and flat on the hips and the shoulder belt can be worn across the shoulder, rather than across the face or neck (usually after your child is 4 feet 9 inches tall).

Water Safety Swimming and playing in the water is fun and good exercise.

▪ Teach your child water safety to prevent drowning.

▪ Make sure your child is able to swim. Learn more about free classes at colinshope.org.

▪ Only let your child swim while supervised by an adult who knows CPR.

▪ If you own a pool, be sure it is enclosed in a fence with a self-closing, self-locking gate. Keep a life preserver and shepherds hook available.

▪ Make sure your child uses a life vest when boating.

Sun Safety Avoid the sun during the hours of 10am to 4pm. If outside, stay in the shade, use a hat to protect your child’s face, and use a sunscreen. Sunscreen with UVA and UVB protection is best. Sun exposure during childhood can cause skin cancer and premature aging of the skin later in life.

Fire SafetyDo not smoke or allow smoking in your home. Install smoke alarms on every level of your home and test the alarms every month.

RESOURCESWebsiteswww.healthychildren.orgA parenting website developed by the American Academy of Pediatrics. Disponible en español. Check out the pages: What’s the Best Way to Discipline My Child? and How to Shape and Manage Your Young Child’s behavior

www.commonsensemedia.org Common Sense Media helps families make smart media choices, with ratings of apps, games and movies.

www.healthychildren.org/English/media Set a family media plan to help establish a healthy balance of family time and “screen-time” for your family.

www.choosemyplate.govUSDA Dietary Guidelines. This website has child-friendly materials and practical information for parents.

Caring for Your School-Age Child: Ages 5 to 12The American Academy of Pediatrics.

Readingrockets.org Web site that has tricks for parents to build reading skills.

24-Hr Appointment Schedulingvisit MyChartARC.com or ARCappointments.com

Same-Day & After Hours Care call your ARC clinic and press “1”

24-Hr Phone Nurse call your ARC clinic and press “4”